APPLICATION FOR LIFETIME SPORTSMAN’S LICENSE

1 Allow up to 5 days for processing. Licenses will only be mailed to the Applicants mailing address (No Exceptions). A copy of this APPLICATION can be used to hunt or fish, provided you attach a copy of the check/money order used as payment, unless paid by credit card, and you meet the age requirement for the LICENSE for which you have applied. Rev 6-19-19 APPLICATION for LIFETIME Sportsman s LICENSE PLEASE TYPE OR PRINT LEGIBLY SEND PHOTOCOPIES NO FORMS WILL BE RETURNED Mail APPLICATION & attachments to: LBRU LIFETIME , 2065 US Hwy. 278, SE, Social Circle, GA 30025 *Please see the reverse side (or 2nd page) for instructions and detailed documentation requirements. Official USPS postmark date on mailed envelope is used for age eligibility request local post office mark. LAST FIRST MI DRIVER S LICENSE # (See Document Req.)

2 * ___ ___ ___ ___ ___ ___ ___ ___ ___ DL STATE MAILING ADDRESS CITY STATE ZIP ___ ___ ___ ___ ___ PHYSICAL ADDRESS Same as Mailing Address CITY STATE ZIP ___ ___ ___ ___ ___ SSN ___ ___ ___- ___ ___ - ___ ___ ___ ___ DATE OF BIRTH M___ ___ D ___ ___Y ___ ___ ___ ___ GENDER Male Female PROOF OF RESIDENCY PROVIDED (See Document Req.)* GA Driver s LICENSE State of GA ID Card EMAIL ADDRESS (Optional, will be used to send a pdf of the issued LICENSE ) PHONE (___ ___ ___) ___ ___ ___ - ___ ___ ___ ____ TEXT NUMBER (optional) (___ ___ ___) ___ ___ ___ - ___ ___ ___ ___ HUNTER EDUCATION # (Requirements listed on back for each LICENSE type)* HUNTER ED STATE COUNTY OF RESIDENCE LIFETIME Licenses restricted to: 1. residents of GA; 2. Nonresidents under 2 years of age; 3.

3 Nonresident grandchildren from 2 years to less than 16 years of age of current resident Paid LIFETIME LICENSE holders (does not include free Senior LIFETIME LICENSE holders). SELECT LIFETIME LICENSE DESIRED (*Supporting Document Requirements Listed on Back) MARK ONE LICENSE Type ** Cost shown includes transaction fee Cost** Req d Fee [ ] Infant (Under 2 Years of Age, resident or Nonresident) $503 [ ] Youth (2 thru 15 years, resident ) $603 [ ] Adult (16 thru 49 years, resident ) $753 [ ] Adult (50 thru 59 years, resident ) $378 [ ] Senior Discount (60+, resident ) $318 [ ] Veterans (Honorably Discharged, resident ) $603 [ ] Military (Active Duty, resident ) $603 [ ] Senior 65+ Sportsman s (Born On or After July 1, 1952, resident ) $73 [ ] Senior 65+ Fishing Only (Born On or After July 1, 1952, resident ) $38 [ ] Senior 65+ Hunting Only (Born On or After July 1, 1952, resident )

4 $38 [ ] Senior 65+ Sportsman s (Born BEFORE July 1, 1952, resident ) - No Card $0, Available Online/Agents [ ] Nonresident Grandchild (2 Years to Less Than 16 Years Old) $1,503 One plastic LIFETIME card is included with your purchase of any of the paid licenses (cost > $0) above. Extra / Replacement Plastic LIFETIME Card(s) (Fee = Qty X $13) Qty ___ $13 ea Grand Total (add the Req d fee + any extra cards) $_____ If this APPLICATION is for a Nonresident Youth Grandchild (2 years to <16 years of age) complete the following: Name of Grandparent with Paid LIFETIME LICENSE : _____ LIFETIME LICENSE Number: _____DOB: ___/____/_____ Tel. No: (____)_____/_____ 16-10-20; A person who knowingly and willfully makes a false, fictitious or fraudulent any manner within the jurisdiction of any department or agency of state , upon conviction thereof, be punished by a fine of not more than $1000 or by imprisonment for not less than five years, or both.

5 Applicant Hunter Education Attestation: * If I was born on or after January 1, 1961, I attest that I will obtain hunter education before using this LICENSE for hunting. If for infant or youth, I will make them aware that any person less than 16 years of age must hunt under adult supervision, except for those 12 to 15 years of age may obtain hunter education to hunt without adult supervision. If paying by credit card, I agree to the charges shown, and acknowledge fees shown are non-refundable. _____ _____ Date Signature of Applicant / Parent / Grandparent Check # _____; or If paying by Credit card, enter card # here:_____ Type of card: Visa MasterCard Discover Expiration Date:____/____/_____ Security Code #_____ Billing Address Zip Code (if different from Mailing Address Zip Code Above) _____ DNR Use: Cash Allow up to 5 days for processing.

6 Licenses will only be mailed to the Applicants mailing address (No Exceptions). A copy of this APPLICATION can be used to hunt or fish, provided you attach a copy of the check/money order used as payment, unless paid by credit card, and you meet the age requirement for the LICENSE for which you have applied. Rev 6-19-19 LIFETIME SPORTSMAN S LICENSE GA Code Reference: This APPLICATION has been developed in accordance with Ga. Code , which establishes the regulations governing the acquisition and possession of LIFETIME Sportsman s Licenses. Definitions: 1. resident : For purposes of this LICENSE , resident is defined as continuous domicile within GA for a minimum of 3 consecutive months immediately prior to procuring LICENSE . Persons may only be a resident of one state. 2. Birth Certificate: For infant, youth, and non- resident grandchild licenses, the required birth certificate is a photocopy of either an original or certified copy of a Birth Certificate / Amended Birth Certificate filed with the State Office of Vital Statistics or equivalent agency in the Applicant's state of birth including Territories and the District of Columbia; hospital issued birth certificates or hospital notices or announcements of birth not accepted.

7 3. Hunter Education: completion of a hunter education course certified or mandated by any state or Canadian providence. Hunter Education not required to purchase a LIFETIME LICENSE , but must be obtained before using it for hunting if born on or after January 1, 1961. Attestation must be signed on the front side of this APPLICATION . Supporting Document Requirements: Applications must be accompanied by the following (NO EXCEPTIONS). Send Copies Only, documents will not be returned. USPS postmark date on mailed envelope is used for age eligibility. Request local post office postmark; otherwise USPS distribution center postmark may be the only postmark applied many days after mailing. Infant: ( resident or Nonresident, Under 2 Years of Age) 1. Photocopy of Child s Birth Certificate (see above for description of required birth certificate).

8 resident Youth: (2 thru 15 years of Age) 1. Photocopy of Child s Birth Certificate (see above for description of required birth certificate), AND 2. Copy of Parent s Picture ID: Current GA Driver s LICENSE or Georgia ID Card issued by Department of Driver Services for parent on the Birth Certificate (not including a GA Driver s LICENSE or Georgia ID Card issued pursuant to - temporary LICENSE ), or court order plus Picture ID showing parental rights if parent not listed on birth certificate, AND 3. Copy of Hunter Education Card: if obtained. Include State where Hunter Ed was acquired. resident Adult: (For age 16 & 17, requires #1 & #2 from resident Youth if ID issued less than 3 months previous) 1. Copy of Picture ID (choose one): Current GA Driver s LICENSE or Georgia ID Card issued by Department of Driver Services (not including a GA Driver s LICENSE or Georgia ID Card issued pursuant to - temporary LICENSE ) AND 2.

9 Copy of Hunter Education Card: if obtained. Include State where Hunter Ed was resident Senior 65+ /Senior Discount 60+ : 1. Copy of Picture ID (choose one): Current GA Driver s LICENSE or GA ID Card issued by Dept. of Driver Services (not including a GA Driver s LICENSE or GA ID Card issued pursuant to , temporary LICENSE ). Free if born BEFORE July 1, 1952. Senior 65+ can also be obtained online & from agents. resident Veterans: (Honorably Discharged) Note: resident Veterans age 50 up consider Adult LICENSE 50-59 yrs. 1. Copy of Picture ID (choose one): Current GA Driver s LICENSE or Georgia ID Card issued by Department of Driver Services (not including a GA Driver s LICENSE or Georgia ID Card issued pursuant to - temporary LICENSE ) AND 2. Copy of DD 214: providing satisfactory evidence that applicant served more than 90 days of federal active duty military service and was honorably discharged AND 3.

10 Copy of Hunter Education Card: if obtained. Include State where Hunter Ed was acquired. resident Military: (Active Duty) Note: resident Military age 50 up should consider Adult LICENSE 50-59 yrs. 1. Copy of Picture ID (choose one): Current GA Driver s LICENSE or Georgia ID Card issued by Department of Driver Services (not including a GA Driver s LICENSE or Georgia ID Card issued pursuant to - temporary LICENSE ) AND 2. Copy of Valid Department of Defense Common Access card with a Uniformed Services Affiliation, AND 3. Copy of Hunter Education Card: if obtained. Include State where Hunter Ed was acquired. Non- resident Grandchild (2 years to less than 16 years of age): 1. Photocopy of Child s Birth Certificate (see above for description of required birth certificate) AND 2. Non- resident Grandchild: Notarized Certification of relationship of LIFETIME LICENSE holder & Grandchild AND 3.